• Heejung Choi, Hyunee Yim, and Min-Jeong Lee.
• Department of Nephrology, Ajou University School of Medicine, Suwon, Korea.
• Medicine (Baltimore). 2023 Oct 6; 102 (40): e35412e35412.

RationaleParoxysmal nocturnal hemoglobinuria (PNH) is a rare hematopoietic stem cell disease with features of hemolytic anemia, thrombosis, and bone marrow failure. Due to intravascular hemolysis and hemoglobinuria, renal dysfunction is often accompanied in PNH patients.Patient ConcernsA 25-year old woman presenting gross hematuria after coronavirus disease 2019 infection was admitted to our medical center. She had mild nausea and headache. She was diagnosed with iron deficiency anemia few years ago and had no other underlying disease. Her laboratory findings showed acute kidney injury (AKI) and severe anemia, with evidences of hemolysis.DiagnosisRenal biopsy was done to determine the cause of renal failure and the result was acute tubular necrosis with deposition of golden pigments, hemosiderin. With pathologic result and laboratory finding of hemolysis, we did flow cytometry for PNH, and the patient was finally diagnosed with PNH.InterventionsWith AKI and oliguria, the patient started to take hemodialysis.OutcomesAfter taking 5 sessions of hemodialysis, the patient's renal function was recovered from AKI. With diagnosis of PNH, the patient is now being treated with complement C5 inhibitor.LessonsThis challenging case tells us that we should consider the first manifestation of PNH as a cause of severe AKI requiring hemodialysis in a patient with anemia and evidence of hemolysis.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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